Ultrasonic diagnosis of gynecologic disorders in children.

During the last five years we have applied diagnostic ultrasound to more than 350 girls under the age of 15 for suspected obstetric and gynecologic disorders. More than 60% of these patients were pregnant and were studied before elective abortion. Many other children were studied for amenorrhea or for the evaluation of a pelvic mass. Sonography has allowed us to successfully distinguish pelvic masses of ovarian origin from those of uterine origin. We have also been able to rule out functioning endocrine tumors in children with precocious puberty. In cases of intersex, sonography has been useful in the older child prior to reconstructive surgery but has played an ancillary role to more invasive procedures in the infant.

The SC phocomelia syndrome: report of two cases with cytogenetic abnormality.

We report two sibs with the SC phocomelia syndrome with typical facial appearance and bilateral absence or extreme hypoplasia of the fibula, radius, and thumb. One sib had bilateral humero-ulnar and femoro-tibial synostosis (absence of the elbow and knee joints). Application of the nosologic criteria of Herrmann and Opitz showed that there was no significant intrafamilial variation in phenotype. Chromosome analyses in both patients showed heterochromatic puffing and centromere separation involving many chromosomes, an observation that has previously been reported in patients with SC phocomelia and Roberts syndromes. More important, this finding will have significance in prenatal detection of a certain proportion of cases with these syndromes without resorting to the use of radiographic examinations.

Chronic eosinophilic pneumonia in a one-year-old child.

Although the literature well describes chronic eosinophilic pneumonia in the adult, there are no reports of this entity in the pediatric age group. We describe a child with chronic eosinophilic pneumonia, emphasizing the specific radiologic features, common conditions in the differential diagnosis, and dramatic response in corticosteroid administration, which is a unique feature of this entity.

Bilateral kidney herniation: complication of cutaneous pyelostomy.

A case of bilateral kidney herniation through cutaneous pyelostomy stomas is reported. The child is doing well after successful closure of the pyelostomies and repair of both ureteropelvic junctions obstructions.

Congenital oesophageal strictures due to cartilaginous rings.

Two cases of distal oesophageal stricture secondary to tracheo-bronchial remnants containing cartilage are presented. The clinical histories and radiographic appearances of these lesions are discussed as is the postulated embryogenesis. A characteristic finding, when present, is the linear collection of barium projecting horizontally from the area of stricture, representing respiratory epithelial ducts.

Familial juvenile adenomatous polyposis.

Most colonic polyps in children are of the juvenile type and occur either as single or scattered colonic polyps. The peak incidence occurs between 4 and 6 yr of age, with a spontaneous decline from 12 to 15 yr. Significant clinical symptoms are rare, and operative therapy is rarely indicated. Diffuse colonic juvenile polyposis, however, varies with different clinical, prognostic, and genetic implications. In infancy, colonic polyposis may be associated with diffuse gastrointestinal involvement leading to fatal complications unless treated aggressively. In childhood, colonic polyposis can occur with a genetic variance with an increased incidence of familial intestinal malignancies. Colonic polyposis in childhood, both familial and nonfamilial, can present with a mixed form of juvenile and adenomatous polyposis. In children with colonic polyposis, the biopsy of a single polyp that reveals the histologic appearance of a juvenile polyp does not rule out the simultaneous existence of adenomatous polyps.

Carbapenem-resistant Enterobacteriaceae rectal screening during an outbreak of New Delhi metallo-ß-lactamase-producing Klebsiella pneumoniae at an acute care hospital.

We describe the results of carbapenem-resistant Enterobacteriaceae (CRE) screening as part of an outbreak investigation of New Delhi metallo-ß-lactamase-producing CRE at a tertiary care university teaching hospital. The manual method for CRE screening was useful for detecting patients with asymptomatic CRE carriage but was time-consuming and costly.

The Older Americans Act: should participants share in the cost of services?

Since its inception in 1965, the Older Americans Act has provided social services free of charge to older people, regardless of income. In recent years, the scarcity of resources has sparked a debate as to whether participants who can afford to pay for services should be required to do so. Of concern is whether charging fees will change the fundamental nature of these popular programs by imparting a "welfare" stigma. Other programs that require fees vary enormously by state, and there has been little documentation of their impact on participation, equity of service delivery, or public attitudes. In order to evaluate current proposals, it is necessary to analyze the distributional effects of the cost-sharing system, how the program will be administered, what impact it will have on service use, which services would be subject to cost sharing and at what income levels, and what constitutes a "reasonable" fee for service.

Evaluation and treatment of chemotherapy extravasation injuries.

Extravasation of chemotherapeutic vesicant agents can result in significant tissue damage, alteration in limb function, and pain. Quality of life for long-term survivors can be severely impacted by negative sequelae from vesicant extravasation. Currently, there is no known preventive therapy. Early detection and intervention are paramount to halt tissue damage and reduce the chance of permanent disability or disfigurement. This article provides an overview of known chemotherapeutic vesicants (mechlorethamine, mitomycin-C, doxorubicin, daunomycin, vincristine and vinblastine), associated theories of tissue destruction, assessment techniques for peripheral intravenous sites, vascular access devices and central venous lines, current treatment strategies, and investigational therapies. A brief discussion of the legal implications of extravasation injuries and recommended key points for medical record documentation are included.

Drug-related complications in infants and children: imaging features.

Iatrogenic disorders continue to be an important cause of morbidity and mortality in infants and children. Most adverse drug reactions have no distinctive radiologic features. Of those with radiologic manifestations, it is usually impossible to differentiate iatrogenic disorders from their spontaneously occurring counterparts. However, certain iatrogenic disorders have distinctive imaging characteristics that allow their recognition in specific patient populations. This review considers a variety of drug-related disorders and phenomena that have been the subject of original articles in the English language literature since 1984.

Triphalangeal thumb.

Triphalangeal thumb (TPT), a rare malformation of uncertain pathogenesis, may occur as an isolated defect, in association with other malformations of the hands, or as a feature of a syndrome or sequence. Isolated TPT occurs in two functional types: opposable and non-opposable. The latter appears to be inherited as a simple autosomal dominant trait, while the former is generally sporadic. TPT is associated with a number of specific malformations of the hand or foot, several of which have a well documented autosomal dominant pattern of inheritance. TPT is a feature of a number of specific syndromes. In this setting it may be associated with radial hypoplasia, bone marrow dysfunction, congenital heart disease, lung hypoplasia or agenesis, anorectal malformations, sensorineural hearing loss, onychodystrophy, mental retardation, and other disorders. TPT serves as a useful marker in such patients; in conjunction with the clinical and radiological findings, it can help to establish the correct diagnosis, leading to appropriate management and genetic counselling.

Infant botulism: a rare cause of colonic ileus.

We have recently seen two patients with infant botulism, one of whom had radiologic evidence of autonomic and neuromuscular dysfunction. Both infants had been fed small amounts of honey, which is often contaminated with Clostridium botulinum spores, during the Jewish New Year celebration.

Ex vivo intracystic contrast studies of multicystic dysplastic kidneys.

PURPOSE: Classically cysts in multicystic dysplastic kidneys are described as noncommunicating. We determined the accuracy of this hypothesis by performing ex vivo intracystic contrast studies of the typical multicystic kidney and hydronephrotic form of the multicystic kidney. MATERIALS AND METHODS: We evaluated 7 multicystic dysplastic kidneys in patients between 2 weeks and 6 months old using intracystic injection of contrast material, including 4 that were typical and 3 with the hydronephrotic form of multicystic disease. Six and 1 kidneys were evaluated ex vivo and percutaneously, respectively. We obtained images during injection and shortly thereafter. RESULTS: When contrast material was injected into 1 cyst, it was eventually seen in most of the other cysts in all 7 kidneys. In 6 kidneys discrete ducts were clearly visualized between the cysts. In the hydronephrotic form of the disease these ducts connected to a pelvis-like structure. When evaluated grossly and the cysts were unroofed, a small orifice was noted in each cyst that sometimes admitted a 3.5F feeding tube. CONCLUSIONS: It is generally thought that multicystic kidneys represent a condition with noncommunicating cysts. We believe that the cysts in most multicystic kidneys communicate whether or not a renal pelvis is present.

Absence and retention of small bowel gas in infants with midgut volvulus: mechanisms and significance.

The radiographic pattern of high intestinal obstruction--gastric and duodenal distension with absence of small bowel gas (ASBG) or a completely gasless abdomen--may be present in infants with midgut volvulus. In most instances, ASBG is associated with viable small bowel. However, when associated with abdominal distension and tenderness ASBG usually reflects strangulated midgut volvulus and bowel necrosis. In some patients with midgut volvulus there is a radiographic pattern of low small bowel obstruction; this is generally associated with necrotic bowel. These seemingly opposite observations can be explained by reviewing the dynamics of gas absorption in normal bowel and in closed loop intestinal obstruction. Impaired blood supply can result in either gaslessness or gaseous distension under differing conditions. Key words: Infant, intestinal tract, intestinal gas, intestinal obstruction, intestinal volvulus, malrotation, gasless abdomen.